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Heart Association gives Vaping qualified nod

The American Heart Association made a radical reversal of policy Monday in it's journal, Circulation. It may not sound like a statement of approval, couched as it is in warnings, and with insistence that it is a "last resort", still, the statement that clinicians may consider advising would-be quitters to try e-cigs, where other methods fail, amounts to a mind-boggling turnaround, given earlier opposition. Press coverage is already significant.

The "Summary Position" includes this statement: "E-cigarettes either do not contain or have lower levels of several tobacco-derived harmful and potentially harmful constituents compared with cigarettes and smokeless tobacco. In comparison with NRTs, e-cigarette use has increased at an unprecedented rate, which presents an opportunity for harm reduction if smokers use them as substitutes for cigarettes."

It may not sound earth shaking, but it is. The Heart Association has turned away from blanket opposition to vaping, toward viewing it as "an opportunity for harm reduction". So although the AHA probably won't sponsor a promotional booth at the next vaping expo, it is indeed a reversal of position, and a miniscule step in the opposite direction.

Of course this modest approval is followed by all the usual caveats about things like possible gateways to nicotine addiction, the feared "renormalization" of smoking, and so forth. In addition, there are concerns about the need for strong laws against sale to minors, concerns the vaping community and industry share of course. So the policy statement doesn't read all that differently than a Stanton Glantz blog. But the UCSF medic whose name went on this document is Neal Benowitz, who has consistently maintained a more moderate stance than his oppositional colleague.

The conclusion of the policy statement, directed at clinicians, contains the following recommendation: "If a patient has failed initial treatment, has been intolerant toward or refused to use conventional smoking cessation medication, and wishes to use e-cigarettes to aid quitting, it is reasonable to support the attempt." And this is the American Heart Association, mind you!

Regarding FDA regulation, the AHA now says: "The regulation should allow for quality-controlled [vaping] products for adults who want to transition from conventional cigarettes to e-cigarettes or to quit or reduce smoking." However, the statement advocates strong regulation and rigorous product certification standards, without any apparent sensitivity to the possibility that this will "give the industry to Big Tobacco," which can easily afford the paperwork that will require, and harm independents that lack such cash reserves.

The statement does evidence concern that Big Tobacco's entry into the market may lead to attempts to use the product in such a way as to maintain cigarette use. The AHA solution is to use taxation to counter this threat. They argue for a tax on e-cigs that is high enough to discourage youth use, "while retaining or increasing differentials with combustible products by increasing taxes on combustibles." At the same time they claim awareness that "a tax that is too high would create a barrier to switching to e-cigarettes among low-income users of combustible tobacco." Of course taxation is regulated by Congress, not by the FDA, so this proposed solution could prove more complex. Big Tobacco would of course lobby hard against it, and they have clout.

Nonetheless, the AHA finally concludes that "if... e-cigarettes are widely available [and cigarette taxes higher], it could potentially help the cigarette smoker to transfer their nicotine addiction from tobacco to a cleaner form of nicotine delivery. This transition could be facilitated by differential taxation and could reduce the burden of cigarette-induced disease."

A modest step, but a step in the opposite direction, which may be grounds for applause.